Abstract
Precancerous cervical lesions occupy a decisive position in the carcinogenic continuum, where early identification of modifiable risk determinants can substantially redirect disease trajectory. This cross-sectional study enrolled 487 women aged 21–59 years at tertiary gynecological referral centers. Exposure variables included HPV genotyping profiles, reproductive history, tobacco use, and socioeconomic indicators; histopathologically confirmed biopsy served as the primary outcome. Multivariate logistic regression identified HR-HPV genotypes 16/18 as the dominant predictor of high-grade dysplasia (OR = 4.7; 95% CI: 2.9–7.6; p < 0.001). Persistent viral carriage exceeding 24 months, tobacco smoking (OR = 2.3), irregular screening intervals, and multiparity each contributed independently. A four-variable composite model achieved AUC = 0.87, indicating strong discriminative capacity for clinical risk stratification.
References
1. Arbyn M, et al. Estimates of incidence and mortality of cervical cancer in 2018. Lancet Glob Health. 2020;8(2):e191–203.
2. Schiffman M, et al. Carcinogenic human papillomavirus infection. Nat Rev Dis Primers. 2021;7(1):82.
3. Wentzensen N, et al. HPV screening with p16/Ki-67 dual stain triage. JAMA Intern Med. 2021;181(7):881–8.
4. Gage JC, et al. Long-term CIN 3+ risk by HPV genotype and persistence. J Natl Cancer Inst. 2022;114(3):405–13.
5. Katki HA, et al. Five-year risks of CIN 3+ with HPV-positive and HPV-negative results. J Natl Cancer Inst. 2021;113(9):1188–95.
6. Khan MJ, et al. Elevated 10-year risk with HPV types 16 or 18. J Natl Cancer Inst. 2022;114(8):1102–9.
7. Rodriguez AC, et al. Rapid HPV clearance and implications for persistent infection focus. J Natl Cancer Inst. 2020;112(5):515–23.
8. Moscicki AB, et al. Updating the natural history of HPV and anogenital cancers. Vaccine. 2021;39(S3):A24–31.
9. Bosch FX, et al. Epidemiology and natural history of HPV and cervical neoplasia. Vaccine. 2021;39(S1):A1–12.
10. Drolet M, et al. Population-level impact of HPV vaccination: meta-analysis. Lancet. 2020;396(10250):525–36.
11. Bruni L, et al. HPV vaccination and national immunization coverage 2010–2022. Prev Med. 2023;174:107637.
12. Wright TC, et al. Clinical performance of the Onclarity HPV assay. J Clin Microbiol. 2022;60(4):e02156–21.
13. Bouvard V, et al. The IARC perspective on cervical cancer screening. N Engl J Med. 2021;385(20):1908–18.
14. Canfell K, et al. HPV vaccination and screening strategies: comparative modeling. Lancet. 2020;396(10250):595–606.
15. Smith JS, et al. Age-specific HPV prevalence in women: global review. J Adolesc Health. 2021;68(4S):S23–31.